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‘Traditional pain medicines can sometimes do more harm than good’

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Dr Anthony Ordman from Integro Medical Clinics
“If patients have already tried cannabis based medicines, we listen carefully to their experience, and try to build on that.” - Dr Anthony Ordman

Pain specialist and Honorary Clinical Director of Integro Medical Clinics, Dr Anthony Ordman tells Sarah Sinclair why cannabis based medicines should be taken seriously as an alternative to conventional medicines – and how we can bring them into the mainstream.

“On balance, the medicines which we traditionally use to treat long-term pain, can do more harm than good,” says Dr Anthony Ordman, a senior pain specialist with more than 25 years experience in treating patients with long-term pain.

“If we’re not careful, we’re in danger of people being made worse by their pain medicines rather than better, for example they may end up over-sedated, but without any reduction in pain.”

Earlier this year, The National Institute of Health and Care Excellence (NICE) published a report on the use of medications for the treatment of long-term pain. It referred to a ‘lack of evidence’ for the long-term effectiveness of many of these medicines, and a risk of long-term harm, advising doctors not to prescribe common painkillers such as paracetamol and ibuprofen for patients with chronic pain.

Dr Anthony Ordman agrees that many conventional medicines have little to offer those living with conditions such as fibromyalgia.

“Doctors may prescribe these medicines in a well-meaning way, but only about a quarter of patients are really helped by them, whereas they all tend to experience side effects including sedation and memory deficit.

They can also tend to get hooked on them and never come off,” he adds.

“We have to find other options.”

As Honorary Clinical Director at Integro, Dr Ordman does offer patients alternative options. These take the form of cannabis based medicines, which he believes can often be more effective for treating chronic health conditions.

“We’ve been aware of the body’s natural endocannabinoid system for a long time. We believe this can become unbalanced in pain states and can often be re-balanced using cannabis based substances,” he explains.

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“Medical science has known about this system for 30 years, but because of drug regulations and a concern among most doctors about the reputation of cannabis medicines, little progress was made.”

But in 2018, the regulations were changed so that medical specialists could prescribe cannabis based medicines. As far as Dr Ordman is concerned cannabis medicines can be a useful part of a whole-person approach to medicine, something which has always been at the heart of his medical practice.

Patient-centered care was a philosophy which he brought this with him to Integro, where patients are looked after by a team of clinical professionals, including a specialist nurse, in order to offer the best treatment possible.

“If patients have already tried cannabis based medicines, we listen carefully to their experience, and try to build on that,” he says.

“We try to work in partnership, rather than a paternalistic way, and there’s always somebody for patients to phone if they have a query or a problem. This is the sort of medicine I have always been keen to practice.”

Rather than just attempting to control pain, as is often the case with opioids, cannabis based medicines can be used to tackle a number of elements associated with pain which might also be affecting the patient’s quality of life, for example anxiety, poor sleep and low mood.

“Adverse life experiences, especially in childhood, can make peoples’ bodies much more prone to chronic pain later on, and what we’re often trying to do is restore balance in body systems which have become unbalanced by these experiences, or by ill-health, injury, and so on,” says Dr Ordman.

“I believe that, for example in fibromyalgia, real neurological changes have happened as a result of intense stress.”

He continues: “A lot of patients with long term pain or anxiety have impaired sleep physiology, so they wake up exhausted, and their body hasn’t had a chance to heal during the night. Cannabis medicines can help restore healthier physiological sleep patterns, which pain medicine now realises can be really important for restoring physical health and reducing pain.

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“Another benefit of cannabis medicines is that they may be able to reduce inflammation in various parts of the body, and many types of pain are driven by inflammation, for example at the sites of injury and arthritis.”

One example is that some patients treated for Crohn’s Disease, an inflammatory condition of the digestive system, who are prescribed cannabis medicines to help manage their pain, may notice a reduction in the frequency of their flare ups as well.

Although Integro Clinics keep their charges to a minimum and have reliable access, via their partner pharmacy to high quality cannabis medicines currently it is mainly those able to afford to purchase their cannabis medicines who are able to access these treatments.

While Dr Ordman acknowledges that some forward-thinking consultants are taking an interest in using medical cannabis, helping more clinicians to understand cannabis medicines is key to seeing wider access through the NHS, he feels.

“The way forward in bringing cannabis based medicines more into mainstream medicine is through the understanding from a doctor’s point of view, that the chemicals in cannabis should just be regarded as molecules, like any other medicine.”

“Just as morphine came originally from poppies, and the heart medicine digoxin came from foxgloves we’re dealing here with chemicals which just happen to come from a cannabis plant. And like morphine or digoxin, these also work on systems that have been present in animals for millions of years.”

He adds: “Patients may tend to view cannabis medicines in a romantic way, because they’re from a cannabis plant, but doctors are more likely to see them in a more matter of fact way, as chemical extracts from cannabis which we can measure and analyse, in proper controlled ways.”

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But patients do have an important part to play, as they are often the most knowledgeable and best-placed to broach the subject of medical cannabis with their doctors. Often they will have tried medical cannabis for their long-term condition and have a good idea of what best suits their condition.

“I think the way into the NHS and broader acceptance may be through expert patient groups and providing scientific and other information that patients can take to their appointments. This could inform their consultants or GP’s and put them in touch with their cannabis medicine doctor in a way that doesn’t seem to be confrontational.”

Dr Ordman is currently inviting a few select NHS colleagues to join him at Integro Clinics, where they would be supported in learning about prescribing cannabis-based medicines for a range of conditions and to carry out much-needed clinical trials.

“We’d love to have a gastroenterologist, a rheumatologist, a psychiatrist, as well as an adult and pediatric neurologist as colleagues at Integro Clinics”, he adds.

“Making lead consultants in the NHS aware of how cannabis medicines can be valuable for patients with hard-to-treat conditions such as intractable pain or epilepsy is important, and there may be other conditions for which cannabis medicines have more to offer, perhaps in conjunction with conventional medicines.”

Find out more and get in touch with Dr Ordman’s team at www.integroclinics.com <http://www.integroclinics.com/>

Integro Clinics Ltd always recommend remaining under the care and treatment of your GP and specialist for your condition while using cannabis based medicines, and the Integro clinical team would always prefer to work in collaboration with them.

Insight

CBD dominant cannabis does not influence driving skills – study

Participants showed no signs of impairment when it came to driving but they did test positive for trace levels of THC

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A study suggests that CBD-dominant cannabis does not influence the skills associated with driving such as reaction time, concentration, time perception or balance.

The Swiss study examined CBD and THC dominant cannabis flowers to see if they impacted on neurocognitive or psychomotor skills.

Some of the participants were given a CBD dominant strain that had a 16.6:0.9 per cent ratio, and others were given a placebo.

After inhaling the cannabis, participants were asked to undergo the Vienna Test System TRAFFIC. This measures reaction time, behaviour in stressful situations, concentration and performance. They also took further tests to determine their fitness to drive, three separate balance tests and coordination along with vital signs such as blood pressure and pulse.

Driving and cannabis

The participants showed no signs of impairment when it came to driving but they did test positive for trace levels of THC in their blood. The blood tests were taken 45 minutes after consuming the CBD dominant cannabis.

The authors noted that the slight change in THC levels within the system would potentially place patients in violation of traffic safety laws.

The researchers noted: “This finding suggests that higher CBD concentrations cause a negative allosteric effect in the endocannabinoid system, preventing the formation of such symptoms. Nevertheless, it is recommended that consumers refrain from driving for several hours after smoking CBD-rich marijuana, as legal THC concentration limits may be exceeded.”

Driving and THC tests

When it comes to THC and roadside testing, new research revealed that THC levels in blood and saliva are poor measures of impairment.

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Researchers analysed a range of studies on the relationship between driving performance and Tetrahydrocannabinol (THC) concentrations in blood and saliva.

The researchers took data from 28 different publications that involved ether ingested or inhaled cannabis. They characterised the relationships between blood and saliva THC concentrations, driving performance and skills such as reaction time or concentration.

When it came to infrequent cannabis users, there were some significant correlations between blood and oral levels of THC and impairments were observed. However, It was noted that these relationships were ‘weak.’

There was no significant relationship noted for the more regular consumers.

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Epilepsy

CBGA may be ‘more potent’ than CBD against seizures in Dravet syndrome

Dr Lyndsey Anderson said there is more to explore when it comes to creating more treatment options for Dravet syndrome.

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Athletes: A row of test tubes containing CBGA oil with a doctors white gloved hand holding one up to the light

Scientists say they have found the ‘Mother of all cannabinoids’ which may help to reduce seizures in Dravet syndrome.

A new study on mice from the University of Sydney found that three acidic cannabinoids found in cannabis reduced seizures in Dravet syndrome, an intractable form of childhood epilepsy.

The three cannabinoids are cannabigerolic acid (CBGA), cannabidivarinic acid (CBDVA), cannabigerovarinic acid (CBGVA). All three but CBGA in particular “may contribute to the effects of cannabis-based products in childhood epilepsy” noted the researchers and were found to potentially have ‘anticonvulsant properties.”

The study marks the first time that three acidic cannabinoids were found to potentially help reduce seizures for Dravet syndrome.

Speaking with Cannabis Health News, the lead author of the study, Dr Lyndsey Anderson, said: “We found that CBGA exhibited both anticonvulsant and pro-convulsant effects. CBGA was more potent than CBD against febrile seizures in a mouse model of Dravet syndrome. We also found that a combination of CBGA and clobazam was more effective than either treatment alone. Additionally, we found that CBGA was anticonvulsant in the maximal electroshock acute seizure model, a model for generalized tonic-clonic seizures.”

She added: “CBGA did, however, present some proconvulsant effects. The frequency of spontaneous seizures in the mouse model of Dravet syndrome was increased with a high dose of CBGA. Also, CBGA was proconvulsant in the 6-Hz acute seizure model, a model of focal, psychomotor seizures.”

Although CBGA shows promise, Dr Anderson also stressed that it needs more research before it can replace CBD. She cautioned that Dravet syndrome patients may still need to proceed with caution.

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“Artisanal cannabis-based products are believed to reduce seizures in Dravet syndrome patients,” she said. “As these oils contain rare cannabinoids like CBGA, it is possible CBGA then contributes to the anticonvulsant effects of these artisanal cannabis oils. However, there were proconvulsant effects observed with CBGA, suggesting that Dravet syndrome patients may need to proceed with caution. The proconvulsant liability of CBGA would need to be addressed before it replaced CBD as an anticonvulsant.”

What is CBGA?

Sometimes referred to as ‘the mother of all cannabinoids,’ CBGA is the precursor molecule to many different cannabinioids including CBD and THC. It is thought to help some diseases such as colon cancer, metabolic disease and cardiovascular disease. It is a non-intoxicating cannabinoid much like CBD.

Dr Anderson explains that more research is needed to explain how the three cannabinoids work together.

“We don’t know how they work together yet,” she said. “We found that CBGA, CBDVA and CBGVA were all individually anticonvulsant against thermally induced seizures in the mouse model of Dravet syndrome. We did not investigate whether a combination of these three cannabinoids would result in a greater anticonvulsant effect than either cannabinoid alone. Future work will definitely explore this possibility.”  

CBGA future research

This isn’t the end of the research into CBGA for Dravet Syndrome. Dr Anderson said there is more to explore when it comes to creating more treatment options for Dravet syndrome.

 

She said: “Next on the horizon for this research is to explore whether the anticonvulsant properties of CBDVA and CBGVA translate to other seizure types including spontaneous seizures in the mouse model of Dravet syndrome. Additionally, we have extensively interrogated the anticonvulsant potential of individual cannabinoids and identified ten with anticonvulsant properties.”

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“We are now interested in investigating what happens when we combine these anticonvulsant properties. It remains an open possibility that greater anticonvulsant effects are achieved when the cannabinoids are administered in combination.”

The study was recently published in the British Journal of Pharmacology (DOI: 10.1111/bph.15661)

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Epilepsy

CBD-enriched cannabis oil may reduce seizures in children with West syndrome

Four of the eight children had less than half the seizures they had before the trial.

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Seizures: A black and blue x-ray of a brain on a black background

A new study on CBD-enriched cannabis oil for seizures involving eight children revealed that electroencephalogram (EEG) abnormalities improved by 20 to 80 percent.

The study on seizures, published online, examines if CBD-enriched cannabis oil used as an add-on therapy could help children with condition that causes spasms. It found that four of the eight children in the trial had less than half the seizures they had before the trial.

The researchers reviewed the experiences of eight West syndrome children who were refractory to anti-seizure medications between May 2020 and March 2021. The children were aged between sixteen to twenty-two months and each received a dose of 25:1 CBD to THC as an add-on therapy.

Seizure decrease

The participants record a mean of 63 seizures per day with the lower rate recorded as 31 and the higher amount recorded as 79.

At the follow-up appointment, two of the patients reported a 75 percent to 99 percent decrease in frequency. A further two children recorded a 50 percent decrease while one patient did not experience any changes at all.

The authors wrote: “The index of EEG (electroencephalogram) abnormalities improved between 20 per cent and 80 per cent in seven patients concurrently with the reduction in seizures.”

“Tolerability among those patients experiencing fewer seizures was good and, overall, “adverse effects were mild and transient.”

Epilepsy seizures

West syndrome is a form of epilepsy. According to Epilepsy Action UK, West syndrome happens in about one in every 2,5000 to 3000 children. This means that about 350 to 400 children will develop the syndrome each year in the UK.

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In 9 out of every 10 children, the first seizures will take place in the first year between three to eight months of age. They may happen in clusters or runs rather than singularly. The children may go on to develop learning difficulties as a result of the syndrome.

Earlier studies

A new study published this month shows that CBD transdermal gel may help to reduce seizures and improve children’s quality of life.

The study, Safety and Tolerability of Transdermal Cannabidiol Gel in Children With Developmental and Epileptic Encephalopathies, was conducted in Australia and New Zealand. It involved 40 children with Developmental And Epileptic Encephalopathies (DEE). The authors noted that the DEEs were the most severe type of epilepsy typically beginning in childhood.

The non-randomised, clinical trial involved CBD gel being applied twice a day for six and a half months on children aged three to eighteen. The gel had a CBD content of 125 to 500 mg.

The researchers found that the gel helped in response to facial impaired awareness seizures potentially reducing them to 44.5 percent. It also helped to reduce tonic-clonic seizures where the muscles violently contract by 22.5 percent. Overall, the seizures in 33 participants were reduced by 43.5 percent.

The children also recorded improvements in alertness, alongside the seizure reduction.

Read More: Study on CBD gel shows potentially positive effect seizures

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